Ch.14, Evolve
A woman who is 14 weeks pregnant tells the nurse that she always had a glass of wine with dinner before she became pregnant. She has abstained during her first trimester and would like to know whether it is safe for her to have a drink with dinner now. The nurse tells her: "Because you're in your second trimester, there's no problem with having one drink with dinner." "One drink every night is too much. One drink three times a week should be fine." "Because you're in your second trimester, you can drink as much as you like." "Because no one knows how much or how little alcohol it takes to cause fetal problems, the best course is to abstain throughout your pregnancy."
"Because no one knows how much or how little alcohol it takes to cause fetal problems, the best course is to abstain throughout your pregnancy." Although the consumption of occasional alcoholic beverages may not be harmful to the mother or her developing fetus, complete abstinence is strongly advised. A safe level of alcohol consumption during pregnancy has not yet been established. The first trimester is a crucial period of fetal development, but pregnant women at all gestations are counseled to eliminate all alcohol from their diet.
A woman who is 32 weeks pregnant is informed by the nurse that a danger sign of pregnancy could be: Constipation Alteration in the pattern of fetal movement Heart palpitations Edema in the ankles and feet at the end of the day
Alteration in the pattern of fetal movement An alteration in the pattern or amount of fetal movement may indicate fetal jeopardy. Constipation is a normal discomfort of pregnancy that occurs in the second and third trimesters. Heart palpitations are a normal change related to pregnancy; they are most likely to occur during the second and third trimesters. As the pregnancy progresses, edema in the ankles and feet at the end of the day is not uncommon.
Which behavior indicates that a woman is "seeking safe passage" for herself and her infant? She keeps all prenatal appointments. She "eats for two." She drives her car slowly. She wears only low-heeled shoes.
She keeps all prenatal appointments. The goal of prenatal care is to foster a safe birth for the infant and mother. Keeping all prenatal appointments is a good indication that the woman is indeed seeking "safe passage." Eating properly, driving carefully, using proper body mechanics, and wearing appropriate footwear during pregnancy are healthy measures that all pregnant women should take.
The nurse advises the woman who wants to have a nurse-midwife provide obstetric care that: She will have to give birth at home. She must see an obstetrician as well as the midwife during pregnancy. She will not be able to have epidural analgesia for labor pain She must be having a low-risk pregnancy.
She must be having a low-risk pregnancy. Midwives usually see low-risk obstetric clients. Nurse-midwives must refer clients to physicians for complications. Most nurse-midwife births are managed in hospitals or birth centers; a few may be managed in the home. Nurse-midwives may practice with physicians or independently with an arrangement for physician backup. They must refer clients to physicians for complications, but patients are not required to see an obstetrician otherwise. Care in a midwifery model is noninterventional, and the woman and family usually are encouraged to be active participants in the care; this does not imply that medications for pain control are prohibited.
With regard to the father's acceptance of the pregnancy and preparation for childbirth, the maternity nurse should know that: The father goes through three phases of acceptance of his own. The father's attachment to the fetus cannot be as strong as that of the mother because it does not start until after birth. In the last 2 months of pregnancy, most expectant fathers suddenly get very protective of their established lifestyle and resist making changes to the home. Typically men remain ambivalent about fatherhood right up to the birth of their child.
The father goes through three phases of acceptance of his own. A father typically goes through three phases of acceptance: accepting the biologic fact, adjusting to the reality, and focusing on his role. Typically, the expectant father's ambivalence ends by the first trimester, and he progresses to adjusting to the reality of the situation and focusing on his role. The father-child attachment can be as strong as the mother-child relationship and can begin during pregnancy. In the last 2 months of pregnancy, many expectant fathers work hard to improve the environment of the home for the child.
Which statement about multifetal pregnancy is not accurate? The expectant mother often experiences anemia because the fetuses have a greater demand for iron. Twin pregnancies come to term with the same frequency as single pregnancies. The mother should be counseled to increase her nutritional intake and gain more weight. Backache and varicose veins are often more pronounced.
Twin pregnancies come to term with the same frequency as single pregnancies. Twin pregnancies often end in prematurity; serious efforts should be made to bring the pregnancy to term. A woman with a multifetal pregnancy often experiences anemia because of the increased demands of two fetuses; this issue should be monitored closely throughout her pregnancy. The client may need nutrition counseling to ensure that she gains more weight than what is needed for a singleton birth. The considerable uterine distention in multifetal pregnancy is likely to cause backache and leg varicosities; maternal support hose should be recommended.
A pregnant woman at 10 weeks of gestation jogs three or four times per week. She is concerned about the effect of exercise on the fetus. The nurse should tell her: "You don't need to modify your exercising any time during your pregnancy." "Stop exercising, because it will harm the fetus." "You may find that you need to modify your exercise to walking later in your pregnancy, around the seventh month." "Jogging is too hard on your joints; switch to walking now."
"You may find that you need to modify your exercise to walking later in your pregnancy, around the seventh month." The nurse should inform the woman that she may need to reduce her exercise level as the pregnancy progresses. Typically, running should be replaced with walking around the seventh month of pregnancy. Physical activity promotes a feeling of well-being in pregnant women. It improves circulation, promotes relaxation and rest, and counteracts boredom. Simple measures should be initiated to prevent injuries, such as warm-up and stretching exercises, to prepare the joints for more strenuous exercise.
An expectant father confides in the nurse that his pregnant wife, at 10 weeks of gestation, is driving him crazy. "One minute she seems happy, and the next minute she is crying over nothing at all. Is there something wrong with her?" The nurse's best response is: "This is normal behavior and should begin to subside by the second trimester." "She may be having difficulty adjusting to pregnancy; I will refer her to a counselor I know." "This is called emotional lability and is related to hormone changes and anxiety during pregnancy. The mood swings will eventually subside as she adjusts to being pregnant." "You seem impatient with her. Perhaps this is precipitating her behavior."
"You seem impatient with her. Perhaps this is precipitating her behavior." The statement in C is the most appropriate response because it gives an explanation and a time frame for when the mood swings may stop. The statement in A is an appropriate response but it does not answer the father's question. Mood swings are a normal finding in the first trimester; the woman does not need counseling. The statement in D is judgmental and not appropriate.
A pregnant woman demonstrates understanding of the nurse's instructions regarding relief of leg cramps if she: Wiggles and points her toes during the cramp. Applies cold compresses to the affected leg. Extends her leg and dorsiflexes her foot during the cramp. Avoids weight bearing on the affected leg during the cramp.
Extends her leg and dorsiflexes her foot during the cramp. Extending the leg and dorsiflexing the foot are the appropriate relief measure for a leg cramp. Pointing the toes can aggravate rather than relieve the cramp. Application of heat is recommended. Bearing weight on the affected leg can help relieve the leg cramp, so it should not be avoided.
An expectant couple asks the nurse about intercourse during pregnancy and whether it is safe for the baby. The nurse should tell the couple that: Intercourse should be avoided if any spotting from the vagina occurs afterward. Intercourse is safe until the third trimester. Safer-sex practices should be used once the membranes rupture. Intercourse and orgasm are often contraindicated if a history or signs of preterm labor are present.
Intercourse and orgasm are often contraindicated if a history or signs of preterm labor are present. Uterine contractions that accompany orgasm can stimulate labor and would be problematic if the woman were at risk for or had a history of preterm labor. Some spotting can normally occur as a result of the increased fragility and vascularity of the cervix and vagina during pregnancy. Intercourse can continue as long as the pregnancy is progressing normally. Safer-sex practices are always recommended; rupture of the membranes may require abstaining from intercourse.
What type of cultural concern is the most likely deterrent to many women seeking prenatal care? Religion Modesty Ignorance Belief that physicians are evil
Modesty A concern for modesty is a strong deterrent to many women seeking prenatal care; for some women, exposing body parts, especially to a man, is considered a major violation of modesty. There are other deterrents. Even if the prenatal care described is familiar to a woman, some practices may conflict with the beliefs and practices of a subculture group or religion to which she belongs. For many cultural groups a physician is deemed appropriate only in times of illness. Because pregnancy is considered a normal process and the woman is in a state of health, the services of a physician are considered inappropriate. Many cultural variations are found in prenatal care, so ignorance is not likely to be a deterrent to women seeking prenatal care.
In understanding and guiding a woman through her acceptance of pregnancy, a maternity nurse should be aware that: Nonacceptance of the pregnancy very often equates to rejection of the child. Mood swings are most likely the result of worries about finances and a changed lifestyle, as well as profound hormonal changes. Ambivalent feelings during pregnancy are usually seen only in emotionally immature or very young mothers. Conflicts such as not wanting to be pregnant or childrearing and career-related decisions need not be addressed during pregnancy because they will resolve themselves naturally after birth.
Mood swings are most likely the result of worries about finances and a changed lifestyle, as well as profound hormonal changes. Mood swings are natural and are likely to affect every woman to some degree. A woman may dislike being pregnant, refuse to accept it, and still love and accept the child. Ambivalent feelings about pregnancy are normal for mature or immature women, young or older. Conflicts about desire to perform childrearing and career-related concerns, however, need to be resolved; the baby's arrival ends the pregnancy but not all the issues.
With regard to medications, herbs, shots, and other substances normally encountered, the maternity nurse should be aware that during pregnancy: Prescription and over-the-counter (OTC) drugs that otherwise are harmless can be made hazardous by metabolic deficiencies of the fetus. The greatest danger of drug-caused developmental deficits in the fetus is seen in the final trimester. Killed-virus vaccines (e.g., tetanus) should not be given, but live-virus vaccines (e.g., measles) are permissible. No convincing evidence exists that secondhand smoke is potentially dangerous to the fetus.
Prescription and over-the-counter (OTC) drugs that otherwise are harmless can be made hazardous by metabolic deficiencies of the fetus. The statement in A is especially true for new medications and combinations of drugs. The greatest danger of drug-caused developmental defects exists in the interval from fertilization through the first trimester, when a woman may not realize that she is pregnant. Live-virus vaccines should be part of postpartum care; killed-virus vaccines may be administered during pregnancy. Secondhand smoke is associated with fetal growth restriction and increases in infant mortality.
